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,� -� <br /> IIUILDING PERIdIT APPLICATION . � . � �" <br /> Applicant Tn Complete This Form „ / . � � _ <br /> � - <br /> IL more than one building is to be constructed, submit a separate permit ap- <br /> plication for each building. A sepaiatc per.mit will be issued for each build- <br /> ing. , <br /> Owncr ���/S �J��%(��� IIuil�i� Address-�`���1 ,�-rH.��:�=�3._ <br /> �iz�i! <br /> Addr�ss �Q/t� S q_iy:/`IJ2- Lot B1Y.. � . Sec. <br /> City .�C�<����� Phone i,�? <i�G��C� Twp. Rge. �c�� ci. <br /> Architect• ��/',/Y.�)�%�C;�oc� - Subdivision (Plat)� � � �vE�: �R� <br /> City J(v-1� Phone ih 2(z1.�', Metes 6 IIounds (Unplatted)—r2iaC-r5 <br /> ' contractor (�f(i�lti'iC �/�/C�L i�o/✓�� <br /> Address ��'�,3 /2� y�i ti�� <br /> City .���!_���' Phone, � v 6���`-' IIuilding U�e _ <br /> State License Number j2; i�i j'l_ y S'd Describe Work to IIe Done ' <br /> Er.pi tatioii Date j - / - "7 (, <br /> ' Use of 13uilding��.����„�i:^�t�w't'i,'�c��._<f5 <br /> �: _�—��_ <br /> '__New _ Addition � epair/P.emod�l <br /> �---" <br /> 'OC� <br /> Valuation of Const:ruction $.3GU�Q '-- <br /> PLOT Pl,lil� <br /> . Indicate lot cize, name of strcets, <br /> indicate location and width of <br /> alleys, locate proposed and all. <br /> er.isti.ng buildings, show distances <br /> to property li.nes, show dist.nccs <br /> �. � betwecn buildings. <br /> LoL sizc � =� .x �� 2 �' <br /> Lot atea S.1'. <br /> Size of 191dy. S.P. <br /> TlumUer of utorics <br /> Uasement <br /> U:c Zone <br /> i f <br /> � � Siyned DY /����cc/ `,L��G�l.�/-- <br /> ' ror <br /> Owner. <br /> DO NOT WRITS I3PIAl0 TH7S 7.IIJli-FOR CITY USL' ONLY <br /> , Uate�Received ���LQ I'7�'- . . Pire Zonc _ <br /> Plan Check Idumbc.�-75-tJ�'L� Typc of Constructiai __ <br /> Valu�tion -'h't`6'�C''- `0� Occupancy Group <br /> Permit Fcc �'�- �'n Occupant Load __ <br /> � Plan Check Fee �`-�• �� �� sprinklerc Rcyuired _ <br /> � .1`otal Fcc Uue �� J� Lr D � <br /> Permit NunJ�cr <br /> i <br /> Datc lssucd �/�/� 7J <br /> � <br /> API'RpVED fp,q �UILDINP PERh11T <br /> �'�r--__."_ <br /> "__P,Y-.-.____._. <br />